“The Doctor Is In”

A Special Tribute to Charles Schultz’s Peanuts
by Leonard J. Hoenig, MD

Since 1950, people of all ages have enjoyed the popular comic strip Peanuts created by the American cartoonist Charles Schultz (1922-2000). One of the endearing young children who star in the strip is Lucy Van Pelt, whose many talents include operating a psychiatric booth and offering humorous insights about life to her brother’s best friend, Charlie Brown. At the front of the booth is a sign that usually reads: “The Doctor Is In”.

Recently, Lucy has had a change of heart and has decided to specialize in dermatology. Her first patient, Charlie Brown, seeks her advice because he has developed hives after eating a snack. After a careful history and examination, Lucy remarks:

“My diagnosis, Charlie Brown, is that You are allergic to Peanuts!”

Lucy explains: the peanut is a legume that can cause serious food allergy with symptoms that include itching, hives, angioedema and anaphylaxis. Allergic individuals should avoid peanut exposure and carry with them an epinephrine auto-injector to treat potential anaphylactic reactions. It is estimated that 0.6% of Americans suffer from peanut allergy.1

Two new promising peanut allergy immunotherapies have completed Phase 3 clinical trials and are pending Food and Drug Administration approval.2,3 The first treatment uses a peanut product AR101 for oral immunotherapy. The second treatment, Viaskin Peanut, is an epicutaneous immunotherapy that is also known as the “Peanut patch”.

A major advance in lowering a child’s risk for developing peanut allergy came from the observation that Jewish children in the United Kingdom had a 10 fold higher prevalence for peanut allergy than did Jewish children in Israel.4 The Israeli infants ate much larger quantities of peanuts, especially in a popular peanut butter snack called “Bamba”. Based on this study and others, the American Academy of Pediatrics has issued guidelines for the early introduction of “infant-safe” peanut protein for infants to prevent peanut allergy, especially in those children at increased risk for the allergy (those with severe eczema and/or egg allergy).5

Lucy hopes that you have enjoyed her first dermatology case history and discussion. She is looking forward to giving more clinical presentations and promises to keep her consultation fees at her customary rate of five cents!

REFERENCES
1. Peanut allergy. Wikipedia. https://en.wikipedia.org/wiki/Peanut­_allergy (accessed November 18, 2018).
2) Update on immunotherapies for peanut allergy.   FARE.
https://www.foodallergy.org/about…/update-on-immunotherapies-for-peanut-allergy (accessed November 18, 2018
3. Perkin MR. Oral Desensitization to Peanuts. N Engl J Med. 2018 Nov 22;379(21):2074-2075
4. Du Toit G, Katz Y, Sasieni P et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. The Journal of Allergy and Clinical Immunology. November 2008: Vol. 122(5) 984-991
5. Sicherer SH. New guidelines detail use of ‘infant-safe’ peanut to prevent allergy. AAP News, January 5, 2017. www.aappublications.org/news/2017/01/05/PeanutAllergy010517  (Accessed November 18, 2018)

Bamba is available on Amazon, Target and else where

Figure 1.
Figure 2. Bamba is available on Amazon, Target and elsewhere

Comments.
1. Brian Maurer, PA-C: Yet another example of how like cures like.
In medical discoveries there is a fine line between wisdom and serendipity.
“And a little child shall lead them….”
Perhaps a greater number of medical specialists could consider charging a nickel for their services.
My two cents.

2. Yael Dolev, Israeli nutritionist and food coach:  I am aware of the research that claims that Israeli are not allergic to peanuts and therefore I was surprised to see a sign on the gate of a school in Tel Aviv that declared “peanuts free Zone”. I am not sure if that is because we just imitate everything American,  or we now have more kids with peanuts allergies, maybe Bamba went out of fashion.  After all it is as addictive a snack as potato chips and no one should eat too much of this. I am not a health professional,  just a food coach who believe that with the right food people can improve their well-being and fight inflammation, and most of all enjoy yummy food.

Reply from Leonard Hoenig:
Thanks for these comments.  Below is a link from a 2017 post about food allergy in Israel.  There is food allergy there, just not as much as in the USA and Israel has begun to implement guidelines for schools on how best to manage students with these allergies. This is an evolving process both here and in Israel. Fortunately progress has been made in our ability to prevent peanut allergy in infants and in immune therapy to mitigate the peanut allergy in those already affected.

Children with Food Allergies in Israel | Nefesh B’Nefesh

https://www.nbn.org.il › … › Government Services › Healthcare & National Insurance 

May 28, 2017 – Unlike many schools in the U.S., most Israeli schools are not peanutfree by default and implementation of allergy-safety policies may vary …
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